Hygeia Foundation Leadership Offers Perspective on a Democratic Model of Clinical Integration

The following is based on one in a series of Integrator blog posts by John Weeks. This one focused on the Hygeia Foundation d/b/a True North Health Center’s democratic model of clinical integration.

The original version of this post initially appeared on Healthy.net. This was updated in 2016 based on Life Cycle of the Hygeia Foundation.

John Weeks’ Summary [updated]: 
One never knows what a discussion will engender. Witness this contribution from the multidisciplinary, clinical / administrative “Decision Circle” of the True North Health Center in Maine. The 9-person group is responding to a portion of the Integrator dialogue on who owns “integrative medicine.” A writer offered a view of an ideal integrative medical model in which members from various disciplines are each respected and then opines that it “doesn’t exist”? The True North team begged to differ. Here we have a look at an existing model. The piece is co-signed by the executive director Thomas Dahlborg, medical director Bethany Hays, MD, an associate medical director, and others. They describe value that has come from “sitting in circle” for major decisions.


I [Weeks] have followed the activities of the Maine-based True North Health Center, from a distance for a number of years. The integrative center offered a widely-respected conference every year and I have on my desk an exceptional commentary of Hays, from Integrative Medicine: A Clinician’s Journal, on the state of birthing practice in the United States.

But it was the heated Integrator dialogue about who owns “integrative medicine” that offered a chance to look inside the True North operation. The precipitating event was the description of an ideal integrative medical model which reportedly “doesn’t exist”? Here is the response, co-signed by True North Decision Circle.


AUTHOR NOTE: The Hygeia Foundation d/b/a True North Health Center has been highlighted by AHRQ, ACP – Internests, npr, Liebert “Green Journal”, AAP, Advance for Nurses, and elsewhere.



Yes, the Model Exists:
A View of Integration from the True North Practitioner Community
-True North “Decision Circle”

We read with great interest the exchange in your last issue and felt compelled to add to the conversation. When we read the description of how an Integrative Medical model would look and his comment “Too bad it doesn’t exist” we wanted to set the record straight – True North’s model was like the one he describes; only (we think) better; and made significant impacts for fifteen years.

True North’s practitioner community was varied: six physicians including primary care, gynecology, chronic disease management, and pediatrics; two advanced practice nurses; three mental health professionals including a psychiatrist, a psychologist, and a specialist in addiction and trauma recovery; and additional licensed, certified, and credentialed practitioners. Patients came to True North through many different “doorways”.

While our original business model
described a case manager role
much like Glidden’s “gatekeeper”
we found that patients preferred
direct access to practitioners
more than they wanted a case
manager type person to assist
with a care plan.
The direct access model improved the practitioner-patient relationship,
patient engagement and activation, patient experience and satisfaction,
practitioner experience and satisfaction,
and led to better outcomes.

As a research nonprofit organization and innovation laboratory True North worked to track results in meaningful ways.

What kept the collegial relationships rich (and healthy) is the choice to use “circle process” as a governance model. Sitting in circle provided literally years of listening to each other, learning from one another and respecting each other across disciplines. We found that coming together as a practitioner community is one of the most meaningful things that we do as a group. One example of this richness was when we held collaborative case presentations where we heard a case and then offer each disciplines’ perspective on how to engage with the patient and family to co-create a pathway with them and each other to position the patient to achieve his or her specific goal.

In addition, our governance model
means that everyone has a seat
at the same table in determining
how the organization runs.Having practitioners and administrators
at the same table is no less fraught
with historical tensions than is having
practitioners from different disciplines.

Still, we learned a lot from each other and through creating and sustaining relationships we manage to get a lot done and serve patients well.

We would like to see groups of practitioners spring up all over the country in similar practice settings because we think the patients and the practitioners are best served when their health care providers are whole and healthy, care about one another, and learn from each other. We think a setting where multiple services are available under one roof gives each modality equal weight in the public’s eye, i.e., doctors and nurses developing mutually healthy relationships. (Clearly the issue of equality or more precisely, lack thereof, is what spurs passionate reactions throughout the healthcare system).
Sincerely, True North’s “Decision Circle”
160711 true north logo

If healthcare leaders, politicians, physicians, nurses or others want to learn more please contact Thomas Dahlborg directly at DahlborgHLG@gmail.com


John Weeks’ Comment: I hope that this letter will serve to open the eyes of any non-MD practitioners who believe that working with medical doctors necessarily means working as subjects to them. The model described here is, in my experience, extraordinary; yet at the same time, the inclusive, democratic intention is shared by many integrative MDs. One of the more interesting aspects of the model, as the Decision Circle members note in the commentary, is not the integration of practitioner types but that of clinical and business personnel: Having practitioners and administrators at the same table is no less fraught with historical tensions than is having practitioners from different disciplines. Fine guidance here. Thanks for this warm wind in what had become a sometimes chilly dialogue. Any other perspectives on integrative clinic decision processes?

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s